Who will care?

Dental educators mount a swift response to Swift's dental care cuts
by C.W. Wolff

Massachusetts Acting Gov. Jane Swift's decision to abandon a health program that provides routine oral care for half a million low-income adults has drawn a quick, unified response from the state's dental schools.

Less than two weeks after Swift proposed eliminating $50 million for the MassHealth program's oral care allocation as part of her attempt to deal with a $2 billion state budget deficit, the deans of Tufts, Harvard and Boston University dental schools and the president of the Forsyth Institute staged a protest at the State House.

Dr. Lonnie H. Norris, center, dean of Tufts School of Dental Medicine, applauds during the State House rally to protest the elimination of routine oral health care for 500,000 low-income Massachusetts residents. Next to Norris is Dominick P. DePaolo, president and CEO of the Forsyth Institute. © Mark Morelli

About 200 people, mainly faculty, staff and students from the four institutions, attended the February 4 rally. Another 100 late-arrivers waited in line to get through the State House security system.

Dire consequences for overall health
"Acting Gov. Swift's plan is regressive and dangerous," Dr. Spencer Frankl, dean of BU's Goldman School of Dental Medicine, told the quiet, but attentive, gathering. "What is at stake is more than the potential loss of teeth. Poor oral health is linked to heart disease, stroke, diabetes and a host of other major health conditions."

The elimination of the program, due to take effect March 15, would leave Medicaid- and Medicare-insured adults, including 100,000 elderly and 150,000 disabled citizens, with dental coverage only for emergencies, extractions and dentures. Fillings, cleanings and routine oral health exams will no longer be covered.

The number of people seeking treatment of dental problems in hospital emergency rooms is likely to increase sharply, notes Dr. Lonnie H. Norris, dean of Tufts School of Dental Medicine. "Hospital emergency rooms are already overloaded. Dental care in the ERÑproviding only palliative care for the particular hour or dayÑalso is much more expensive than routine office visits and preventive care."

Norris also is concerned about the impact on dental students, especially in their future attitudes about providing care for under-served populations. "We are not only training future dentists in technical skills, but influencing what they think about reaching out to the community and helping everyone. If they are denied the chance to do that in their training, they won't do it as practitioners.

"We also teach them comprehensive care and not just taking out teeth and giving people dentures. It's important they learn the goal should be to save teeth as well as the fact that preventive care is vital to systemic health care."

The financial impact on the dental school's overall budget will be small, according to Norris, especially since MassHealth coverage for children is expected to continue. "However, the impact on the overall health of under-served populations in the Commonwealth will be great," he noted.

State Rep. Kathleen Teahan, D-Abington, is heading the Massachusetts legislative protest of the decision to eliminate the oral care program. © Mark Morelli

The impact for dental students
The number of adult patients and the scope of procedures dental students are routinely exposed to may change drastically. Two-thirds of patients treated at the Tufts dental school clinics are low-income.

"We teach our students how to do every type of procedure to be competent dentists," says Norris. "If you tell them we are going to wipe out this block of restorative procedures and just do extractions, it is not consistent with the principles of modern dental education and could affect their attitudes about treatment alternatives."

Chances are slim that the governor will reverse her decision to cut the program, only one of many slashed from the budget. But people concerned with its looming elimination continue to write letters, make phone calls and sign petitions. "We are hopeful that these necessary services will be funded again in future budgets," says Norris.

State Rep. Kathleen Teahan, D-Abington, who spoke at the rally and introduced a dozen of her colleagues, has spearheaded legislative protest of the cuts. Also speaking was the director of oral health for the Boston Public Health Commission, the president of the Massachusetts Dental Society and a disabled Harvard dental school patient who won't be able to afford to maintain her oral health without the program.

A need that will go unmet
The need for dental care for the state's low-income populations was called a "crisis" not long ago in a report of the special legislative commission on oral health. The state receives more calls from poor people seeking dental careÑabout 4,000 a monthÑthan for any other area of health care. (Callers seeking mental health care rank second with about 700 inquiries a month.)

Massachusetts used to be considered a leader in funding oral health services. But the MassHealth program has been hindered for years by a lack of participating dentists. In fact, only 17 percent of the state's 5,000 private dental practitioners take MassHealth patients. Low reimbursement ratesÑ50 percent or less than regular feesÑhave discouraged private practitioners from getting involved with the program.

In addition, the state insists dentists in the program must treat all MassHealth patients who seek their treatment. Headway was made last year when some reimbursement fees were raised, according to Dr. Richard LoGuercio, president of the Massachusetts Dental Society. More gains were hoped for this year, he said.